What is the recommended first intervention for suspected tension pneumothorax in an unstable patient?

• A. Chest tube insertion
• B. Needle decompression
• C. Pericardiocentesis
• D. Thoracentesis

Answer: (B)

In unstable trauma patients with suspected tension pneumothorax, the priority is to rapidly relieve the intrapleural pressure to restore venous return and improve cardiac output. The quickest way to do this is needle decompression, performed immediately to vent the trapped air and stabilize circulation. After decompression, proceed with a chest tube thoracostomy for definitive management and lung re-expansion. Other procedures target different problems and don’t provide the rapid relief needed in this situation.